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Thoracic surgeons in lung cancer management: A comprehensive triple-line approach – current insights

Non-small cell lung cancer (NSCLC) is highly diverse, but treatment has improved, particularly with immune checkpoint inhibitors and targeted therapies. Surgery has advanced with minimally invasive techniques, precision surgery, and salvage options.

In 2020, lung cancer ranked as the second most diagnosed cancer and the leading cause of cancer-related deaths, with 2.2 million new cases and 1.8 million fatalities. Early detection through low-dose CT screening has helped improve outcomes. Lung cancer, primarily non-small cell, presents various subtypes and clinical complexities, necessitating accurate classification for better treatment decisions and molecular marker assessment, facilitated by the WHO classification. The TNM staging system further guides therapeutic strategies based on the disease stage. Recent advancements in lung cancer management have transformed the field, emphasizing a patient-centered, multidisciplinary approach. Minimally invasive surgical techniques like VATS and RATS have become preferred choices for early-stage NSCLC, offering improved short-term outcomes and decreased morbidity. Enhanced Recovery After Surgery (ERAS) programs and rehabilitation further optimize patient care, focusing on reducing stress, pain, and hospital stays while promoting early mobilization and nutrition. Precision surgery, acknowledging patient and tumor heterogeneity, is paramount. Preoperative planning, lesion localization, and 3D reconstructions aid in accurate resection, offering personalized treatment strategies. Sub lobar resection, including wedge and segmentectomy, is increasingly considered for early-stage cases, preserving lung function. Management of recurrence and second primary lung cancers involves less invasive diagnostic techniques like bronchoscopy biopsy and CT-guided biopsy. Salvage surgery is a consideration in select cases following immunotherapy, although outcomes vary, necessitating rigorous patient selection. The evolving landscape of lung cancer management underscores the importance of integrated, personalized treatment pathways to optimize patient outcomes.


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